Asian Journal of Neurosurgery

Cranial dural arteriovenous (AV) fistulas are abnormal connections between the branches of dural arteries to dural veins or venous sinuses. They are most frequently located at the transverse sinus and cavernous sinus. They can occur at every cranial dural sinus. Dural AV fistula of falx cerebri is rare. A 62-year-old female presented with signs and symptoms of raised intracranial pressure. Radiological imaging revealed a dural AV fistula at the posterior one-third falx cerebri. She underwent transarterial embolization, and complete obliteration of the fistula was achieved...

Understanding the anatomy of the vertebral artery is essential while manipulating the craniovertebral joint during surgery. Its anomalous course in congenital atlantoaxial dislocation makes it more vulnerable to injury. Preoperative dedicated computed tomography (CT) angiography helps identify the artery's position and plan for surgical procedure. A 13-year-boy presented with neck pain and spastic quadriparesis for 1 year. Radiological imaging of the craniovertebral junction revealed atlantoaxial instability with basilar invagination...

Introduction  Adrenaline-soaked wicks are often employed to decongest nasal mucosa during transsphenoidal pituitary surgeries to ensure proper hemostasis and visibility of the operating field. Considerable debate exists regarding the optimum concentration of adrenaline that strikes a balance between hemostasis as well as the hemodynamic side effects of adrenaline. This study assessed cardiac indices like cardiac output and cardiac index using a FloTrac Vigileo cardiac output monitor to compare two different concentrations of adrenaline used for topical instillation...

Introduction  Bypass surgery is a challenging operative procedure that requires surgical excellence. Achieving the skills required for vascular surgery is difficult to master in the operating room without intensive microsurgical training. Various models have been developed to provide training to young neurosurgeons and increase dexterity and patient safety. Bypass surgery requires complex microsurgical techniques. Methods  Microanastomosis training was performed on plastic tubes and chicken wings for 2 months...

Background  Many recent studies show that exoscopes are safe and effective alternatives to operating microscopes (OM). Developments of robotics and automation are present in neurosurgery with the appearance of a newer device such as RoboticScope (RS) exoscope with a digital three-dimensional (3D) image and a head-mounted display. The body of the RS is connected to a six-axis robotic arm that contains two video cameras, and serves as stereovision. This robotic arm allows accurate 3D camera motions over the field of view, giving the user a great degree of freedom in viewpoint selection...

Background  Basal ganglia hemorrhage (BGH) is a severe neurologic condition associated with significant morbidity and mortality, and its optimal management remains a topic of debate. Our study assessed the surgical outcomes of BGH patients at the 3-month mark using the modified Rankin Scale (mRS). Methods  This retrospective observational study was conducted over 10 years at an advanced neuro-specialty hospital in Eastern India, including patients who underwent decompressive craniotomy and hematoma evacuation...

The use of the indocyanine green video angiography (ICG-VA) both endoscope and microscope has become popular in recent decades thanks to the safety, efficacy, and added value that they have provided for cerebrovascular surgery. The dual use of these technologies is considered complementary and has helped cerebrovascular surgeons in decision-making, especially for aneurysm clipping surgery; however, its use has been described for both aneurysm surgery, resection of arteriovenous malformations, or even for bypass surgeries...

Introduction  Cerebrospinal fluid leak (CSF) after a neurosurgical procedure is a known complication that may result in bad outcomes (1). The incidence of CSF leak varies based on the site involved; it ranges from 4 to 32% for transsphenoidal to posterior fossa procedures. The costs involved in treating postoperative CSF leaks increases exponentially that becomes a barrier in continuing optimum treatment. There are many studies that compare the different treatment modalities and even use of sealing agents but none give an algorithm of management...

Objectives  The choice of inhalational or intravenous anesthetic agents is debatable in neurosurgical patients. Desflurane, a cerebral vasodilator, may be advantageous in ischemic cerebral pathologies. Hence, we planned to compare desflurane and propofol in patients with moyamoya disease (MMD) with the objective of comparing neurological outcomes. Materials and Methods  This prospective pilot trial was initiated after institutional ethics committee approval. Patients with MMD undergoing revascularization surgery were randomized into two groups receiving either desflurane or propofol intraoperatively...

This case report presents a rare anatomical variant of the torcular Herophili, characterized by a circular configuration and the absence of the left transverse sinus. A 12-year-old child presented with intermittent holocranial headaches, and imaging revealed the circular torcular Herophili along with mild ventricular enlargement. The straight sinus drained into the left side of the circular torcular Herophili. Following lumbar puncture and cerebrospinal fluid (CSF) drainage, the child experienced symptom improvement...

An 86-year-old woman with initially asymptomatic severe right common carotid artery stenosis had frequent transient left hemiparesis 2 years after the initial diagnosis. Magnetic resonance angiography and three-dimensional computed tomography angiography demonstrated short-segment occlusion of the right carotid bifurcation with significant circumferential calcification, while magnetic resonance imaging demonstrated no ischemic lesions. No collateral blood flow through the anterior communicating artery and posterior communicating artery was observed...

Introduction  Approximately 2.5% of fatalities from cancer are caused by brain tumors. Even though there is literature regarding prognostic factor of adult brain tumor, studies often resort to Western demographics. Hence, we conducted this retrospective observational study to compare the demographic characteristics and prognosis in patients of glial tumors in Indian population with histological diagnosis with respect to age. Materials and Methods  A single-center retrospective observational study with 76 patients of glioma who had been treated with surgery combined with radiotherapy with or without chemotherapy was conducted...

Purpose  The aim of this study was to evaluate the role of permeability surface area product in grading brain gliomas using computed tomography (CT) perfusion Materials and Methods  CT perfusion was performed on 33 patients with brain glioma diagnosed on magnetic resonance imaging. Of these, 19 had high-grade glioma and 14 had low-grade glioma on histopathological follow-up. CT perfusion values were obtained and first compared between the tumor region and normal brain parenchyma. Then the relative values of perfusion parameters were compared between high- and low-grade gliomas...

Older populations have been increasing recently, resulting in an increase in cases of pyogenic spondylitis. Neurosurgeons who frequently treat the elderly are at a higher risk of encountering this condition. Therefore, this article provides a summary of the literature and our experience to help neurosurgeons effectively manage pyogenic osteomyelitis. It is important not to rule out pyogenic spondylosis when examining a patient with back pain, even in the absence of a fever. This is because the chronic type is common, easily overlooked, and early diagnosis and treatment are crucial...

Aim  The aim of this study was to perform a bibliometric analysis of the articles published on posterior instrumentation of cervical spine and to study the general publishing trends over the years in this topic in terms of journals, authors, topics, keywords, collaborating countries, etc. Material and Methods  Articles were searched on the web of science using appropriate keywords. A bibliometric analysis was performed using Bibliometrix R package Results  A total of 1,953 studies were identified between 1991 and 2023 including 1,782 articles and 171 reviews from 198 sources...

Subdural empyema is the collection of purulent material between the dura mater and arachnoid. Subdural empyema most often occurs due to the direct extension of local infection. But spontaneous subdural empyema is a rare entity. In literature, not many cases of spontaneous subdural empyema by Escherichia coli are reported. Here we report a case of spontaneous subdural empyema along with a review of literature who was previously treated on the suspicion of encephalitis with urinary tract infection and then brought to our hospital...

Posterior fossa tumors are one of the most common tumors occurring in children. These tumors are often operated in the Concorde or prone position. Venous congestion can occur due to neck flexion during the positioning causing macroglossia. We report a case of a lingual abscess in a child after surgery in the Concorde position. There was no preoperative evidence of any lingual and dental complaints or injury during intubation. We hypothesize that the lingual abscess in the immediate postoperative period was secondary to venous stasis during the positioning for surgery...

Objective  This study compared intraoperative findings with preoperative computed tomography angiography (CTA) and computational fluid dynamics (CFD) analysis of perianeurysmal findings for the indication of possible vessel wall thinning. Materials and Methods  Participants comprised 38 patients with unruptured middle cerebral artery aneurysms treated by surgical clipping at our hospital between May 2020 and April 2021. We defined parent artery radiation sign (PARS) as the presence of each of the following three findings in CFD analysis based on preoperative CTA: (1) impingement of the stream line on the outer parent vessel wall of the aneurysm; (2) radiation of wall shear stress vectors outwards from the same site; and (3) increased wall pressure compared with the surrounding area...

Posterior fossa localization of a hydatid cyst is uncommon; in these cases, the cyst usually locates in the cerebellum. Localization within the subarachnoid spaces or the cerebrospinal fluid ventricular system is exceptional. In the present report, which appears to be the seventh in the literature, we describe two cases of a hydatid cyst in the cerebellopontine cistern. Magnetic resonance imaging findings revealed a nonneoplastic cystic lesion mimicking an arachnoid cyst. The hydatid nature of the cyst was unexpected preoperatively...

In neuroendovascular treatment, there are many opportunities to guide multiple catheters into the intracranial blood vessels. We report the relationship between two microcatheters according to the guiding order with experimental in vitro studies. We hypothesize that in a bent blood vessel such as a paraclinoid region of the internal carotid artery, the catheter that was first guided tended to pass through the inside, and the catheter that was guided later tended to pass through the outside. The in vitro verification was performed using a microcatheter and a balloon catheter in a silicone vascular aneurysmal model...